Response to treatment, mortality, and CD4 lymphocyte counts in HIV-infected persons with tuberculosis in Abidjan, Côte dʹIvoire

We examined the severity of immune deficiency in patients with HIV-associated tuberculosis in Côte dʹlvoire and assessed its effect on mortality and response to treatment. Consecutive patients attending a tuberculosis treatment centre in Abidjan with smear-positive pulmonary or clinically diagnosed extrapulmonary tuberculosis were tested for HIV-1 and HIV-2 infections and had CD4 lymphocyte counts measured. Patients received standard short-course chemotherapy. Analysis of outcome (restricted to smear-positive tuberculosis patients) was done at 6 months. The 247 HIV-positive patients were significantly more likely than the 312 HIV-negative patients to have CD4 lymphocyte counts of less than 200/μL (43% vs 1%; odds ratio 56·9; [95% Cl 19·7-185·3]) and 200-499/μL (39% vs 14%, odds ratio 3·8; [2·5-5·9]). Among HIV-positive patients, median CD4 lymphocyte counts in those with extrapulmonary tuberculosis (198/μL; N=67) was lower, but not significantly so, than among those with pulmonary tuberculosis (257/μL; N=180). Among 460 patients with pulmonary tuberculosis, the overall mortality rate was significantly higher in HIV-positive than HIV-negative persons (6% vs 0·4%; relative risk 17·1 [2·2-131·4]), and increased with the severity of immune deficiency; mortality rates in HIV-positive patients with CD4 counts of <200/μL and 200-499/μL were 10% and 4%, relative risk 27·6 (3·5-220·8); and 11·5 (1·2-109), respectively, compared to HIV-negatives. Among patients completing treatment, cure rates were similar in HIV-positive patients (93%) and HIV-negative patients (92%), and were not related to CD4 counts. Severity of immune deficiency was the major determinant of mortality in HIV-associated tuberculosis. Among people completing treatment, microbiological response was satisfactory irrespective of serological or immune status.